What We Can Learn from Cases of Synchronous Acute Mesenteric Obstruction and Nonocclusive Mesenteric Ischemia: How to Reduce the Acute Mesenteric Ischemia-Related Mortality Rate

Mitsuyoshi, Akira; Tachibana, Tsuyoshi; Kondo, Yuhei; Momono, Teppei; Aoyama, Hideyasu

doi:10.1016/j.avsg.2015.11.010

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…First, the catheterization of and arterial infusion for the dissected aorta are essential, and more safety procedures were required than expected. We performed catheter-directed infusion of a vasodilator into the SMA because we believe that vasodilator therapies are the most important management option for all patients with NOMI; the resection of necrotic bowels cannot resolve spasms, which can recur by additional invasion, especially in such severe conditions [ 3 ]. Although treatments with catheter and cannulation into the SMA in the dissected aorta are essential techniques, this procedure is safe and highly efficient [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…We performed catheter-directed infusion of a vasodilator into the SMA because we believe that vasodilator therapies are the most important management option for all patients with NOMI; the resection of necrotic bowels cannot resolve spasms, which can recur by additional invasion, especially in such severe conditions [ 3 ]. Although treatments with catheter and cannulation into the SMA in the dissected aorta are essential techniques, this procedure is safe and highly efficient [ 3 ]. Recent developments in endovascular techniques and instruments enable us to perform more safety procedures than in the previous era; thoracic endovascular aortic repair and stenting for isolated SMA dissection are good examples [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nonocclusive mesenteric ischemia (NOMI) refers to a mesenteric arterial spasm and intestinal ischemia and is a highly lethal disease; the mortality rate of NOMI is reported to be 70–90% [ 1 , 2 ]. Treatments include the catheter-directed and infusion of vasodilatory and antispasmodic agents and open surgery, which is often required for necrotic bowels [ 3 ]. Open surgery cannot resolve the spasms and may worsen the situation [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Treatments include the catheter-directed and infusion of vasodilatory and antispasmodic agents and open surgery, which is often required for necrotic bowels [ 3 ]. Open surgery cannot resolve the spasms and may worsen the situation [ 3 ]. However, the safety and effectiveness of catheterization for NOMI with type B aortic dissection (AD) have not yet been elucidated [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of nonocclusive mesenteric ischemia with type B aortic dissection using intra-arterial catheterization after trauma surgery: case report

et al. 2018

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BackgroundNonocclusive mesenteric ischemia (NOMI) is a mesenteric arterial spasm and intestinal ischemia. This disease is a highly lethal disease because diagnosis and decision of appropriate treatments are often difficult. Operations cannot resolve the spasms and may worsen the situation. However, the safety and effectiveness of catheterization for NOMI with aortic dissection (AD) have not yet been elucidated. Here, we report a successful case of early diagnosis and treatment of NOMI with type B AD involving the superior mesenteric artery (SMA) using the intra-arterial infusion of a vasodilator via the SMA.Case presentationAn 83-year-old man was admitted to our hospital because of abdominal pain after a motor accident. We performed intestinal resection and splenectomy for intestinal perforation and splenic hemorrhage and treated conservatively for acute AD, liver injury, renal hematoma, and pneumothorax. On postoperative day (POD) 2, the patient had localized abdominal pain. Follow-up computed tomography suggested a smaller superior mesenteric vein sign and segmental lack of enhancement in the intestinal wall and ascites without SMA occlusion. Thus, the patient was diagnosed with NOMI. Although the patient had type B AD including the SMA, we performed selective mesenteric arteriography and transcatheter papaverine infusion via the SMA and prostaglandin via the peripheral vein. Seven days post treatment, mesenteric blood flow improved and intestinal wall enhancement was restored.ConclusionThe intra-arterial infusion of a vasodilator is highly efficient and safety treatment option for NOMI with type B AD. Prompt and accurate management can prevent massive small bowel resection, and this procedure is essential in resolving a spasm independent of whether a necrotic bowel has been resected.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of nonocclusive mesenteric ischemia with type B aortic dissection using intra-arterial catheterization after trauma surgery: case report

et al. 2018

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“…In refractory cases, vasodilator infusion with papaverine, nitroglycerin, and prostaglandins has been described, but experience has been largely anecdotal, and the dose, duration, and selection of drugs have not been standardized. 14 , 15 …”

Section: Discussionmentioning

confidence: 99%

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Magee

Plotkin

Bowser

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Vasospasm immediately after lower extremity arterial bypass may represent an uncommon cause of early graft failure. We report a successful case of catheter-directed, intra-arterial continuous vasodilator infusion to salvage a bypass graft threatened by severe, refractory vasospasm after incomplete response to nicardipine, verapamil, and nitroglycerin boluses. A continuous nitroglycerin infusion was administered for 24 hours, by which time the vasospasm resolved. At 12 months postoperatively, the graft remained patent with normal results of vascular laboratory studies. This report demonstrates that in cases of refractory vasospasm after peripheral bypass, continuous vasodilator infusion can be an effective treatment to prevent early graft failure.

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Evaluation and management of the surgical abdomen

Bradley

Garraway

2020

Current Opinion in Critical Care

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Purpose of review The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill. Recent findings Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approaches, including catheter-directed thrombolysis, may decrease need for laparotomy in the appropriate patient. Nonocclusive mesenteric ischemia remains a challenging diagnostic and management dilemma. Acalculous cholecystitis is managed with a percutaneous cholecystostomy and is unlikely to require interval cholecystectomy. Surgeon comfort with intervention based on point-of-care ultrasound for biliary disease is variable. Mortality for toxic megacolon is decreasing. Summary Physical examination remains an integral part of the evaluation of the surgical abdomen. Interpreting laboratory investigations in context and appropriate imaging improves diagnostic ability; intravenous contrast should not be withheld for critically ill patients with acute kidney injury. Surgical intervention should not be delayed for the patient in extremis. The intensivist and surgeon should remain in close communication to optimize care.

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What We Can Learn from Cases of Synchronous Acute Mesenteric Obstruction and Nonocclusive Mesenteric Ischemia: How to Reduce the Acute Mesenteric Ischemia-Related Mortality Rate

Cited by 5 publications

References 8 publications

Treatment of nonocclusive mesenteric ischemia with type B aortic dissection using intra-arterial catheterization after trauma surgery: case report

Treatment of nonocclusive mesenteric ischemia with type B aortic dissection using intra-arterial catheterization after trauma surgery: case report

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Evaluation and management of the surgical abdomen

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